Botulinum neurotoxin (BoNT) has been successfully used to treat primary headache
syndromes but there is no published data on its use for chronic post craniotomy
headache. BoNT-A (4:1 dilution) was injected at a dose of 15-50 units into
peri-incisional sites of the scalp in three patients who had remotely undergone
craniotomy for traumatic epidural hematoma. All patients reported reductions in
headache lasting at least 2.5 months. Repeat injections were performed in all
cases with favourable outcomes. There were no complications. Peri-incisional
BoNT-A appears to be a potentially valuable tool in the chronic management of
post craniotomy headache following traumatic brain injury.